In a world filled with COVID-19…
Cin can Strike At any Moment
It’s time to take a crucial new look at chemotherapy-induced neutropenia (CIN), the dire consequences of leaving patients unprotected, and how the COVID-19 pandemic changed the standard-of-care guidelines.
The risk is here – and it’s real
The current COVID-19 pandemic is making everyone pause and revisit their approach to cancer therapy and treatment, especially when it comes to protecting patients from infection. Current treatment guidelines for cancer patients were recently expanded in the wake of the pandemic.
To further protect patients, current treatment guidelines are now recommending to:
Expand prophylactic use of granulocyte-colony stimulating factor (G-CSF) to minimize the risk of febrile neutropenia, thus not adding to the overwhelming number of cases in emergency departments (EDs) and hospitals.1,†
- Change the threshold for the use of G-CSF with regimens from only high risk (>20% risk of febrile neutropenia) to intermediate (10%-20% risk of febrile neutropenia) or high risk.1
Expand therapeutic use of G-CSF if patients previously not on G-CSF develop febrile neutropenia to include all patients, not just those with a risk factor for complications. The primary goal would be to minimize days of hospitalization.1,†
Cautionary statement: Physicians may wish to avoid the use of or discontinue G-CSF in case of respiratory infection, respiratory symptoms, or confirmed or suspected COVID-19 to avoid an increase in pulmonary inflammation or hypothetical risk of increasing inflammatory cytokines associated with adverse outcome.1
Today, patients may pay a heavy price
CIN increases a patient’s risk of infection and disrupts their immune defense mechanisms, which may interfere with treatment.2
These repeated infections and subsequent lowered absolute neutrophil counts potentially result in chemotherapy treatment delays and dose reductions.2
They also could lead to costly extended or repeated hospitalizations and eventually decreased survival.3,4
When relative dose intensity (RDI) is affected, the consequences can be dire
Novel Approaches to CIN Prevention Are in Development
Today, the current standard of care for preventing CIN in intermediate- and high-risk patients has limitations. Current preventive therapies provide only a small reduction in infection-related mortality and leave patients vulnerable to infection, febrile neutropenia, and hospitalizations. But novel therapeutic approaches are on the horizon.2
Disrupted chemotherapy can directly compromise outcomes
References:
- National Comprehensive Cancer Center. NCCN hematopoietic growth factors. NCCN.org. Accessed August 20, 2020. https://www.nccn.org/covid-19/pdf/HGF_COVID-19.pdf
- Gupta A, Abbasi B, Gupta S. Management of chemotherapy induced neutropenia—an unmet clinical need. Am J Biomed Sci & Res. 2019;4(5):313-318.
- Halpern MT, Yabroff KR. Prevalence of outpatient cancer treatment in the United States: estimates from the Medical Panel Expenditures Survey (MEPS). Cancer Invest. 2008;26(6):647-651.
- Centers for Disease Control and Prevention. Information for health care providers. Preventing infections in cancer patients. Centers for Disease Control and Prevention website. Updated December 16, 2019. Accessed June 29, 2020. https://www.cdc.gov/cancer/preventinfections/index.htm
- Crawford J, Denduluri N, Patt D, et al. Relative dose intensity of first-line chemotherapy and overall survival in patients with advanced non-small-cell lung cancer. Support Care Cancer. 2020;28(2):925-932.
